神经病学（英文）9.Epilepsy.pptVIP

第十二章 癫癎 (Epilepsy) Department of Neurology, The 2nd affiliated hospital, Harbin Medical University Section 1 Introduction 是指纯感觉性、运动性和精神运动性发作，或指每次发作及每种发作的短暂过程，患者可同时有一种或几种癎性发作。 A group of disorders characterized by recurrent seizures. 临床上可表现为运动、感觉、意识、行为和自主神经等不同程度的障碍 Idiopathic epilepsy is mainly influenced by hereditary factors（mono-genic or polygenic inheritance）. It can be a partial seizures or generalized seizures. which has a better response to drug therapy. Brain injury: 发作期间出现高电压细胞膜去极化，即发作性去极化漂移(paroxysmal depolarization shift, PDS)，将近发作时，PDS后超极化不再发生，代之以高频率的动作电位群，并通过突触联系和强直后易化作用诱发外围及远处的神经元同步放电。 (2) Environmental influence I. Age：多种特发性癫癎的外显率与年龄有密切关系； II. Endocrinosity：如经期性、妊娠性癫癎； III. Sleep: GTCS, West syndrome, benign childhood epilepsy with centro-temporal spikes Epidemiology Newly onset patients: 650,000~700,000/year. 75% of them shows good response to anticonvulsants of first choice. About 25% of them shows refractory seizures. There are at least 1,500,000pastients with refractory seizures national wide. -单个病理灶的致痫灶多位于病理灶的边缘 -广泛性癫癎病理灶的致痫灶常包含其内， 有时在远离癫癎病理灶的同侧或对侧脑区 2. EEG is the most common used test in distinguishing seizures from other causes of consciousness. However, a normal or nonspecifically abnormal EEG never excludes the diagnosis of seizures. Video-EEG 对诊断困难者应用是提高癫癎诊断水平的重要手段。有助于鉴别癫癎与非癎性发作、确定癎性灶及癫癎的正确诊断和分类 Neuro-image examination 确定脑结构性异常或损害，MRI较CT为更敏感。 Section 2 partial seizures Partial seizures can be divided into three clinical types depending upon whether the consciousness is retained or impaired. I.单纯部分性发作(simple partial seizures), no disorder of consciousness II.复杂部分性发作(complex partial seizures), with the loss of consciousness III.继发全身性强直-阵挛发作(secondary GTCS) (2) Complex partial seizures: commonly caused by birth trauma. Other etiological factors are encephalitis, brain trauma, tumor, cerebrovascular accident, cerebral arteriosclerosis, cerebrovascular malformatio